New insights and improved strategies for the management of primary spontaneous pneumothorax.

The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management.

Feasibility, acceptability and effectiveness of integrated care for COPD patients: a mixed methods evaluation of a pilot community-based programme.

Question Under Study: The aim of this study was to assess the feasibility, acceptability and effectiveness of a pilot COPD integrated care programme implemented in Valais, Switzerland.

Methods: The programme was adapted from the self-management programme Living Well with COPD, and included the following elements: self-management patient-education group sessions, telephone and medical follow-ups, multidisciplinary teams, training of healthcare professionals, and evidence-based COPD care. A process and outcome evaluation of the pilot phase of the programme was conducted by means of qualitative and quantitative methods.

Factors associated with cessation of smoking among Swiss adults between 1991 and 2011: results from the SAPALDIA cohort.

Introduction: Smoking is still the most preventable cause of disease and premature death in Switzerland, as elsewhere. We aimed to assess the main determinants of smoking cessation in the population-based cohort of SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults).

Methods: The SAPALDIA study was initiated in 1991 with 9651 participants aged 18 to 60 years from eight areas (S1).

Spontaneous pneumothorax: time to rethink management?

There are substantial differences in international guidelines for the management of pneumothorax and much geographical variation in clinical practice. These discrepancies have, in part, been driven by a paucity of high-quality evidence. Advances in diagnostic techniques have increasingly allowed the identification of lung abnormalities in patients previously labelled as having primary spontaneous pneumothorax, a group in whom recommended management differs from those with clinically apparent lung disease.

ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax.

Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.

Spirometer Replacement and Serial Lung Function Measurements in Population Studies: Results From the SAPALDIA Study.

The Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults (SAPALDIA), a population cohort study, used heated-wire spirometers in 1991 and 2002 and then ultrasonic spirometers in 2010 revealing measurement bias in healthy never smokers. To provide a practical method to control for measurement bias given the replacement of spirometer in long-term population studies, we built spirometer-specific reference equations from healthy never smokers participating in 1991, 2002, and 2010 to derive individualized corrections terms. We compared yearly lung function decline without corrections terms with fixed terms that were obtained from a quasi-experimental study and individualized terms.

[Alveolar proteinosis: a cause of immunodeficiency].

Alveolar proteinosis is a rare disease, characterized by accumulation of surfactant in alveoli. Various forms have been identified (congenital, secondary or auto-immune). Treatment is to be reserved for patients that experience moderate to severe symptoms.

Primary malignant achromic melanoma of the lung.

Currently, less than thirty cases of primary malignant melanoma of the lung have been reported in the literature. Thus, strict criteria for diagnosis have been published and include: malignant melanoma associated with bronchial epithelial changes; a solitary lung tumor; no prior history of skin, mucous membrane, intestinal or ocular melanoma; and absence of any other detectable tumor at the time of diagnosis. In this article we present a case of melanoma of the lung without evidence of extra-pulmonary disease.

Serum bilirubin is associated with lung function in a Swiss general population sample.

Bilirubin is a strong antioxidant. Increased serum levels have been associated with lower respiratory disease and mortality risk. We studied the association of bilirubin with lung function in the Swiss study on Air Pollution and Lung Disease in adults (SAPALDIA) cohort.

Primary spontaneous pneumothorax: a diffuse disease of the pleura.

Primary spontaneous pneumothorax (PSP) is by definition not associated with any underlying lung disease. However, this does not mean that there is no underlying pathological process. It has become increasingly apparent over recent years that PSP is associated with diffuse and often bilateral abnormalities within the pleura and is not simply a disease caused by ruptured blebs/bullae.

[Health promotion from the 20th to the 21th century. The Valais Ligue for fighting tuberculosis--a visionary model started in 1951].

At the beginning of the twentieth century, tuberculosis was really a plague. Many people had been mobilised to successfully fight against this infectious disease. Valais, a Swiss alpine canton developped then an original concept of health promotion by involving all the health partners including a specialised hospital under the auspices of the local Health Departement.

Titrated sedation with propofol for medical thoracoscopy: a feasibility and safety study.

Background: Bispectral index (BIS) is a valuable tool for assessing the depth of sedation and guiding the administration of sedative drugs. We previously demonstrated the benefits of BIS-guided propofol sedation in patients undergoing flexible bronchoscopy.

Objective: To examine the feasibility and safety profile of propofol sedation in patients undergoing medical thoracoscopy (MT).

[Cystic fibrosis, a paradigm for modern medicine].

Cystic fibrosis is the most frequent and severe genetic disorder in caucasian children. It is a multisystemic disease progressively involving many organs. Patients' survival was poor most of them dying as children.

[Foreign bodies and hemoptysis: about danger of ingesting blister-wrapped tablets].

A case of hemoptysis may be challenging for clinicians because of the many etiologies involved in this differential diagnosis. Sometimes the cause of this symptom may be very surprising. We present a case of hemoptysis due to ingestion of a blister.

[Medical thoracoscopy].

Medical thoracoscopy (MT) remains a mini-invasive and very efficient technique to diagnose pleural diseases. In case of pleural effusion of unknown etiology its diagnostic yield is higher than 90%. MT also allows to perform cheap and successful pleurodesis by simple talc insufflation in case of recurring pneumothorax and invalidating malignant pleural effusion with very poor quality of life despite repeated thoracocentes.

Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery.

Background: Perioperative acute kidney injury (AKI) is associated with increased mortality and morbidity. Our aim was to evaluate the incidence and determinants of AKI using the risk, injury, failure, loss of function, and end-stage kidney disease (RIFLE) criteria in thoracic surgical patients.

Methods: We retrospectively analyzed a cohort of patients undergoing lung cancer surgery from 1996 to 2009.

Comparison of cardiac output as assessed by transesophageal echo-Doppler and transpulmonary thermodilution in patients undergoing thoracic surgery.

Study Objective: To evaluate the accuracy of cardiac index (CI) as measured by echo-transesophageal Doppler monitoring (echo-TDM) with CI measured by the transpulmonary thermodilution technique.

Design: Prospective, observational study.

Setting: University hospital.

[Referring to an unusual case: pulmonary affection and rheumatoid arthritis].

We report the case of a 60 year female patient suffering from rheumatoid arthritis for the last 25 years, under TNF-blocker and leflunomide, affected by a recurrent pneumothorax with several subpleural nodules, basal bronchiectasis and apical bullous emphysema. The patient was administered several treatments: aspiration, talc pleurodesis, surgical pleurodesis, pleurodesis induced by tetracycline and autologous blood. To allow the pleural inflammatory reaction necessary to the success of the pleurodesis, we had to interrupt the treatment by TNF-blocker and leflunomide.